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Translating research into practice: a community-based medication management intervention

TRANSLATING RESEARCH INTO PRACTICE:
A COMMUNITY-BASED MEDICATION MANAGEMENT INTERVENTION
by
Gretchen Elizabeth Alkema
________________________________________________________
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(GERONTOLOGY)
May 2007
Copyright 2007 Gretchen Elizabeth Alkema

Translational research in the health sciences involves three key phases linking basic research findings to application through interventions promoting the health and welfare of aging individuals. Type II translation disseminates efficacious guidelines and interventions proven through randomized clinical trials into applied settings and evaluates their continued effectiveness in the new environment. This dissertation evaluated a Type II translation project, the Community-Based Medication Management Intervention (CBM Intervention), funded through the Administration on Aging's Evidence-Based Prevention Programs Initiative. The CBM Intervention was a collaborative effort to implement a medication management screening and intervention protocol, originating from a home healthcare randomized clinical trial, in a Medi-Cal waiver care management program serving dually-eligible, functionally impaired older adults (N=615). This dissertation analyzed the sample's prevalence of medication problems, effectiveness of the intervention to resolve identified problems, and staff perceptions of implementing an evidence-based practice into care management. The guiding conceptual framework was the Promoting Action on Research Implementation in Health Services (PARIHS) framework.; A four problem criteria was used to screen for medication problems; nearly half of the sample (N=299) had a potential problem. The highest problem prevalence was for those with inappropriate therapeutic duplication. A focused pharmacy review confirmed medication problems for 29% of the sample. Predictors of an identified problem included advancing age, Caucasian, newly enrolled in care management, health service utilization, and number of medications. Participants with a confirmed problem engaged in a pharmacist-driven intervention (N=162) and 61% had the problem resolved.; A questionnaire developed for this dissertation assessed care manager perspectives on implementing an evidence-based practice into care management. Nurse and social work care managers (N=29) had differing perspectives on their scope of practice concerning medicationmanagement, and those working at the same site as the project's facilitation team expressed more positive responses to the implementation process and benefits of medication management.; This dissertation demonstrated the complexities of Type II translation and highlighted lessons learned for the CBM Intervention and translational research as a whole. Key issues included challenges between implementation fidelity and adaptation, the impact of professionaldifferences, and importance of facilitation activities and leadership on implementation success.

TRANSLATING RESEARCH INTO PRACTICE:
A COMMUNITY-BASED MEDICATION MANAGEMENT INTERVENTION
by
Gretchen Elizabeth Alkema
________________________________________________________
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(GERONTOLOGY)
May 2007
Copyright 2007 Gretchen Elizabeth Alkema